We spoke to a number of experts involved in the operation of new care models to ask what practical guidance they can offer on building a successful organisation, beginning with managing board meetings.
There’s often confusion around the role of the board
Ross Clark, Partner at Hempsons, tells us there’s often confusion around the role of the board. He says: “The role of the board is strategic. It needs to… make decisions linked to a business plan that leads the organisation into the future.”
“The role of each individual director is to say his, or her, mind,” adding that a board chair is pivotal. “The chair needs to manage that meeting, so that means starting on time, having an agenda, but crucially allowing people to talk but not to talk for too long and pulling people in who haven’t contributed.”
Graeme Cleland, Managing Director at Taurus Healthcare Ltd adds that “Keeping everybody focused and accepting that everybody has a different perspective is really key. Creating diversity on your board is really important so there are key individuals. You need clinicians, you need practice management, you need proper organisational management and you need leadership”.
Time is without doubt the single biggest pressure on partners
Planning and strategy for the practice is obviously vital but difficult in practical terms. We asked our experts how they find the time for it.
Ross indicated the answer lies in delegation, he recommends allocating business strategy to a small team – although that can be hard in a small practice. In these circumstances it may even be possible to employ a strategic consultant.
A second consideration is to look at the Sustainability and Transformation plan, to find out the wider strategic developments within the area. It’s a plan developed by the council, the local authority, the CCG and other providers for integrating health and social care across that community. “It’s fundamental that practices know what that entails because that will shape their own strategic direction,” adds Ross.
Dr Riaz Jetha GP and clinical lead for working at scale in his CCG, echoes Ross in saying it’s about finding the right people to do the job. “In my experience, organisations do have people who are particularly motivated by this aspect of their work and I would let them run with it, but that needs to be balanced with them being able to take on board the views of other colleagues, so everyone has a voice.”
Minute meetings and show outputs
Riaz highlights that GPs can often feel uncomfortable if others in the practice are taking time out from seeing patients to work on strategy. He believes it’s important that meetings are minuted and there is recognition for what’s being achieved. In terms of promoting collaboration he explains, “There’s lots of collaboration software out there, such as Basecamp and WhatsApp that can help keep the conversation going and be a really good repository for storing your documents and ideas.”
With collaboration key to sharing the development of strategy, we asked what else can GPs do to improve communication within the practice.
Iron out the issues in the first 100 days
Riaz states: “As we start creating more complex GP organisations, communication tends to crescendo at go-live and then unfortunately, it rapidly falls off. In my experience the most successful mergers are ones that iron out the organisational issues in the first 100 days. After that, people tend to lose belief.”
It’s key that during those first 100 days, you keep on reiterating to your team why you’re merging, and iron out any individual issues. Riaz points out that there are many ways of communicating, but his tip is to keep it short and simple and ensure there is someone in charge of communicating to everyone.
Ross adds that the most successful organisations are the ones that are communicating constantly, rather than just via annual board meetings. He emphasises that things work best when there’s a good flow of communication between board, shareholders and practice.
Get the IT system on a common platform
Standardising methods across practices is another idea that can make new care models work more smoothly. IT is a common area where practices coming together may be on different platforms.
Ross says when practices are working together and merging they need to look at the systems in place and ideally get everyone on the same platform. He also points out that: “If you’re working with other practices without merging with them, then you may be sharing information about patients to what is effectively a third party and it may end up being a breach of the Data Protection Act.” He advises refreshing patient consents if they’re not expansive enough.
The indemnity requirements of the organisation should be reviewed
Dr Helen Hartley, Head of Underwriting Operations & Deputy Head of Underwriting Policy at Medical Protection, told us when things go wrong, patients often seek to claim redress from an individual practitioner. However, lawyers may also approach a practice for “where things go wrong because of back office function, for example a result showing a cancer is misfiled or not placed in front of the appropriate healthcare professional.” Consideration should therefore be given to the overall organisation requirements and how these may have changed. Helen says Medical Protection also recommend “individual indemnity for any nurses, pharmacists or paramedics taking on senior roles within a general practice where they are assessing or treating patients”.
In order for the new collaboration to be successful, management protocols should be adopted. It’s essential to have a board that acts strategically and communicates effectively with its shareholders and practice. The first 100 days of a merger are key to get everyone on board, Practices must act swiftly and use this time wisely, meetings should be minuted and attention paid to good communication within the practice.
In this way, organisations have the best chance of success.
GPs can gain other practical ideas from a good management skills course. One of our panel experts, Dr Riaz Jetha is a facilitator with Red Whale, who offer their ‘Lead Manage Thrive’ course.
Visit https://www.gp-update.co.uk/course/lmt to find out more.